Insight, analysis & opinion from Joe Paduda

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Friday catch-up

Buried in a project and travel this week, so missed a few things worthy of note.

Health care reform

From PwC, a new report on the evolution of primary care.  Key takeaways – The “consumer” of primary care is changing to more elderly and more Hispanic buyers; who delivers primary care is changing as big retail outfits get involved, and reimbursement is getting better too.

A thoughtful piece from Health Affairs unpacking the recent news of health care spending growth.  Important note – remember this is OVERALL growth, not per-insured.  As insurance covers more Americans, it isn’t surprising that health care costs increase as well.

Work Comp

WCRI is out with a revealing studies about California post-reform.  The California study indicates early results show medical costs are down about 5 percent since 2012’s reform implementation.  

There’s a related study just out from CWCI – an exhaustive analysis of the UR/IMR process and results therefrom. Key takeaway – the estimated approval rate for all California workers’ comp medical services ranges between 95.7% and 96.1%.

Had a very interesting evening talking with a couple dozen Wall Street folks about workers’ comp earlier this week.  Interesting because a) it’s still surprising to me that anyone in the investment community really focuses on work comp; b) most were pretty knowledgeable about the space; and c) I learned a lot about the “secondary debt market” for privately held company debt.

Key takeaways:

  • lots of interest in work comp fee schedule dynamics
  • actual dynamics of the specialty services buying process are not well understood
  • so-called white space (un-penetrated accounts, service leakage to non-participating providers) a very hot topic

Other things of interest

Have you heard of the Cochrane Collaboration?  It’s an organization that produces:

systematic reviews and meta-analyses which encompass all of the studies both published and unpublished on a particular [medical] question, studies that have been analyzed and statistically combined to create a summary of what is reliably reliable.

Here’s an excerpt [highlights are mine]

Think of the body of medical procedures, screening programs, and drug treatments as a pie. If you were to divide that pie into thirds, the first third would contain all of those procedures or treatments that we know are underpinned by quality medical research and for which we can truly say with some degree of certainty that they “work.” The second piece of pie would contain those things we routinely do but we don’t have strong evidence that the benefits exceed the harms, because they haven’t been well studied. The last third would contain many things that we do in medicine and health care where there is evidence that they do more harm than good, and we should stop doing those things.

An interesting piece from Harvard Business Review on “why no one is reading your white paper.” I’d suggest it’s also because no one cares – that is, your white paper has to speak to a specific problem that person has.

If it doesn’t, it may be interesting but it won’t be effective.  Effective defined as inspiring that person to do something.

Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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